Türk Nöroşirürji Dergisi 2003 , Vol 13 , Num 2
Türker KILIÇ1, Selçuk PEKER1, Deniz KONYA1, Feyyaz BALTACIOĞLU3, Saruhan ÇEKİRGE2, M. Necmettin PAMİR1
1Marmara Üniversitesi Tıp Fakültesi Nöroşirürji, Anabilim Dalı, İstanbul
2Hacettepe Üniversitesi Radyoloji, Anabilim Dalı, İstanbul
3Marmara Üniversitesi Radyoloji, Anabilim Dalı, İstanbul
Treatment guidelines have been formed for arteriovenous malformations (AVM) less than 4 cm in size. Most of these are Spetzler Martin grade III or less. Microsurgical, radiosurgical and endovascular modalities all provide satisfying results, with minimal differences in surgical outcome according to the localization of the vascular malformation. However AVM's with anidal diameter larger than 4 cm's pose difficulties in treatment. This group mostly consists of Spetzler Martin grade IV and V. One therapeutic alternative in this group is to use a multimodality approach utilizing radiosurgery after endovascular approaches. This prospective study aims to discuss the treatment results of 89 AVM cases treated with GammaKnife radiosurgery after embolization.

Methods: 31 of 89 patients have a 2 year angiographical follow-up and 30(97%) of these have a change in nidal size. 24 of these (78%) were total obliteration, 6 (19%) were 50-80% decrease in nidal size. 1(3%) of patients who have more than two year follow up does not have a change in nidal diameter.

Results: 1 (1.1%) of patients with combined therapy within 1 year after the Gamma-Knife surgery. 3 (l%) of AVM's treated with Gamma-Knife radiosurgery suffered fatal intracerebral hemorrhage within 1 year after treatment. Patients treated with combined endovascular and Gamma-Knife treatment suffered no permanent mobidity attributable to the tretment.

These results provide data in favor of management of large AVM's by combination treatment of embolization and gamma-knife radiosurgery. Anahtar Kelimeler : Arteriovenous Malformation, GammaKnife, Radiosurgery, Embolization